{"id":1782,"date":"2020-08-17T13:27:39","date_gmt":"2020-08-17T13:27:39","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/pericardium\/"},"modified":"2022-05-05T18:20:23","modified_gmt":"2022-05-05T16:20:23","slug":"pericardium","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/pericardium\/","title":{"rendered":"Pericardium"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><div class=\"intro\">The pericardium is a membrane that covers the heart and the roots of vessels that arise from it.<\/div><\/p>\n\n\n\n<div id=\"attachment_18901\" class=\"wp-block-image\"><figure class=\"aligncenter\"><a href=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/07\/pericardium.png\" target=\"_blank\" title=\"Pericardium\"><img decoding=\"async\" src=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/07\/pericardium-600x600.png\" alt=\"\" class=\"wp-image-18901\"\/><\/a><figcaption><strong>Figure 1.<\/strong> Layers of the heart&nbsp;(Credit: Blausen.com staff (2014),&nbsp;<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0<\/a>)<\/figcaption><\/figure><\/div>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Layers<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">The pericardium consists of two layers:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Fibrous layer<\/strong>\u00a0(external)<\/li><li><strong>Serous layer<\/strong>\u00a0(internal)<\/li><\/ul>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\"><\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Fibrous pericardium<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">The tough, external layer, composed of dense connective tissue.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Continuous with the&nbsp;<strong>tunica adventitia<\/strong>&nbsp;of the great vessels superiorly and is tethered to the diaphragm inferiorly via the&nbsp;<strong>pericardiophrenic ligament<\/strong><\/li><li>Connect at the anterior surface to the posterior surface of the sternum via&nbsp;<strong>sternopericardial ligament<\/strong><\/li><li>At the&nbsp;<strong>posterior surface,<\/strong>&nbsp;connects to the posterior surface of the mediastinum via loose connective tissue<\/li><li>The fibrous pericardium is continuous with the pretracheal layer of the deep cervical fascia<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Serous pericardium<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The soft, internal layer, composed of the mesothelium.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Has a&nbsp;<strong>parietal layer<\/strong>&nbsp;that is in direct contact with the fibrous pericardium, and a<strong>&nbsp;visceral layer<\/strong>&nbsp;which attaches to the heart (the&nbsp;<strong>epicardium<\/strong>)<ul><li>The two layers are continuous with each other<\/li><li>Between the two layers, we find the&nbsp;<strong>pericardial cavity&nbsp;<\/strong>which contains ~50mL&nbsp;of pericardial fluid for lubrication<\/li><\/ul><\/li><li>The parietal layer surrounds the great vessels<\/li><\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image\" id=\"attachment_18911\"><a href=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/07\/heart_layers.png\" target=\"_blank\" title=\"Pericardium\"><img decoding=\"async\" src=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/07\/heart_layers-600x417.png\" alt=\"\" class=\"wp-image-18911\"\/><\/a><figcaption><strong>Figure 2.<\/strong> Layers of the heart&nbsp;(Credit: OpenStax,&nbsp;<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0<\/a>)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Pericardial sinuses<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">The pericardial sinuses are two potential spaces in the pericardium:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The<strong>&nbsp;transverse sinus&nbsp;<\/strong>is a communicating sinus (you can insert a finger that will reach to the other side \u2014 as visualized below) that&nbsp;can be found between the arch of the aorta and pulmonary trunk, and the superior vena cava<ul><li>To find the transverse pericardial sinus, insert a finger and separate the superior vena cava from the arch of the aorta and pulmonary trunk<\/li><li>During cardiac surgery, it allows a surgeon to isolate the pulmonary trunk and ascending aorta and apply a temporary ligature or clamp<\/li><\/ul><\/li><li>The&nbsp;<strong>oblique sinus&nbsp;<\/strong>is a blind-end sac (cul-de-sac) formed at the posterior aspect of the heart, between the pulmonary veins<ul><li>Separated from the transverse sinus by a double-layer of serous pericardium<\/li><\/ul><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image\" id=\"attachment_18747\"><a href=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/07\/transverse-sinus.png\" target=\"_blank\" title=\"Pericardium\"><img decoding=\"async\" src=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/07\/transverse-sinus-600x493.png\" alt=\"\" class=\"wp-image-18747\"\/><\/a><figcaption><strong>Figure 3. <\/strong>The transverse sinus<\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Neurovasculature<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><tbody><tr><td>Blood supply<\/td><td>Mainly by the&nbsp;<strong>pericardiophrenic artery<\/strong>, which arises from the<strong>&nbsp;internal thoracic artery<\/strong><br><br><em>The identification of the pericardiophrenic artery can be done by finding the small artery that is parallel to the phrenic nerve<\/em><br><br>Other, smaller contributors:<br><strong>Musculophrenic artery<\/strong>&nbsp;\u2014 The terminal branch of the internal thoracic artery<br><strong>Thoracic aorta<\/strong>&nbsp;\u2014 Bronchial, esophageal, and superior phrenic branches<br><strong>Coronary arteries<\/strong>&nbsp;\u2014 Can supply the visceral layer of serous pericardium<\/td><\/tr><tr><td>Venous drainage<\/td><td><strong>Pericardiacophrenic veins<\/strong>&nbsp;which join the brachiocephalic veins and internal thoracic veins<br>Branches of the azygos venous system<\/td><\/tr><tr><td>Innervation<\/td><td>Phrenic nerves (C3\u2013C5)<br>Sympathetic trunk<br>Vagus nerves<\/td><\/tr><tr><td>Lymphatic drainage<\/td><td>Subepicardial plexus \u2192 anterior and posterior mediastinal nodes \u2192 bronchomediastinal nodes.<\/td><\/tr><\/tbody><\/table><figcaption><strong>Table 1.<\/strong> The neurovasculature of the pericardium.<\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Clinical information<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>In the case of\u00a0<strong>pericarditis<\/strong>\u00a0(inflammation of the pericardium):<ul><li>We can hear the friction of the surfaces of the pericardium. The rustling sound may be heard over the left sternal border and upper ribs.<\/li><\/ul><ul><li>The same nerve that innervates the pericardium (phrenic nerve) also supplies the the skin of the shoulder area (C3-C5), which can explain why the pain can radiate to the shoulder.<\/li><\/ul><\/li><li><strong>Cardiac tamponade\u00a0<\/strong>is a life-threatening medical emergency in which the pericardium becomes filled with fluid (blood), preventing the heart from pumping efficiently.<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Layers<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Fibrous pericardium<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Serous pericardium<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Pericardial sinuses<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Neurovasculature<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Clinical information<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Layers The pericardium consists of two layers: Fibrous layer\u00a0(external) Serous layer\u00a0(internal) Fibrous pericardium The tough, external layer, composed of dense connective tissue. Continuous with the&nbsp;tunica adventitia&nbsp;of the great vessels superiorly and is tethered to the diaphragm inferiorly via the&nbsp;pericardiophrenic ligament Connect at the anterior surface to the posterior surface of the sternum via&nbsp;sternopericardial ligament At [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1773,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1782","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pericardium &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/pericardium\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/pericardium\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/pericardium\\\/\",\"name\":\"Pericardium &#8211; 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